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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1521895

Changes in donor lymphocyte infusion for relapsed patients post-hematopoietic stem cell transplantation: A 30-year single-center experience

Provisionally accepted
Yusuke Uchibori Yusuke Uchibori 1Shuhei Kurosawa Shuhei Kurosawa 1Yuho Najima Yuho Najima 1*Kyoko Haraguchi Kyoko Haraguchi 1Daichi Sadato Daichi Sadato 1Chizuko Hirama Chizuko Hirama 1Yasutaka Sadaga Yasutaka Sadaga 1Kaori Kondo Kaori Kondo 1Chika Kato Chika Kato 1Satoshi Sakai Satoshi Sakai 1Yasuhiro Kambara Yasuhiro Kambara 1Fumihiko Ouchi Fumihiko Ouchi 1Masashi Shimabukuro Masashi Shimabukuro 1Atsushi Jinguji Atsushi Jinguji 1Naoki Shingai Naoki Shingai 1Takashi Toya Takashi Toya 1Hiroaki Shimizu Hiroaki Shimizu 1Takeshi Kobayashi Takeshi Kobayashi 1Hironori Harada Hironori Harada 1,2Yuka Harada Yuka Harada 1Yoshiki Okuyama Yoshiki Okuyama 1Noriko Doki Noriko Doki 1
  • 1 Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
  • 2 Tokyo University of Pharmacy and Life Sciences, Hachioji, Tōkyō, Japan

The final, formatted version of the article will be published soon.

    Donor lymphocyte infusion (DLI) is a therapeutic approach for relapse after hematopoietic stem cell transplantation (HSCT). Despite their reported efficacy, the evolution of DLI practices over time remains underexplored. This study provided a comprehensive analysis of DLI strategies and outcomes over 30 years at a single institution. A retrospective analysis was conducted on 75 patients who underwent DLI for disease relapse between April 1994 and March 2024. The primary endpoint was the 3-year overall survival (OS) rate after DLI. Secondary endpoints included the 100-day complete remission (CR) rate and incidence of acute graft-versus-host disease (GVHD). The median age at the first DLI was 49 years (range, 20-69 years). The most common underlying diseases in all 75 cases were acute myeloid leukemia (AML, n = 46) and myelodysplastic syndromes (MDS, n = 12). Until 2014, DLI was only performed in patients with AML (n = 14), MDS (n = 2), or chronic myeloid leukemia (n = 5).However, since 2015, patients with various diseases, including lymphoid malignancies, have also undergone DLI. The 3-year OS rate was 29.1% (95% CI, 18.8-40.2%). Factors negatively influencing OS included age ≥50 years and a high or very high refined disease risk index. The 100-day CR rate was 52.1%, and acute GVHD occurred in 25.3% of the patients, with no strong correlation between GVHD incidence and CR achievement. Among 18 patients who underwent three or more DLIs since 2018, 88.9% achieved remission following DLI or second HSCT, with a median follow-up of 949.5 days for survivors. This study highlighted the evolving trends in DLI practices and the diversification of 3 combination therapies. Future research should focus on further validating these findings and optimizing DLI protocols to improve patient outcomes.

    Keywords: Donor lymphocyte infusion, Hematopoietic Stem Cell Transplantation, refined disease risk index, Acute graft-versus-host disease, Acute Myeloid Leukemia, Myelodysplastic Syndromes, Azacitidine, venetoclax

    Received: 03 Nov 2024; Accepted: 02 Jan 2025.

    Copyright: © 2025 Uchibori, Kurosawa, Najima, Haraguchi, Sadato, Hirama, Sadaga, Kondo, Kato, Sakai, Kambara, Ouchi, Shimabukuro, Jinguji, Shingai, Toya, Shimizu, Kobayashi, Harada, Harada, Okuyama and Doki. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yuho Najima, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

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